from the annual meeting of the Society for Academic Emergency Medicine:

The dirty little secret about the recently released ACC/AHA 2009 Focused Update on the Diagnosis and Management of Heart Failure is that even though the guidelines proudly trumpet an all-new section on hospitalized patients with acute heart failure, the writing committee didn’t include any emergency physicians–the people expected to actually use the guidelines.

So much for lip service regarding the importance of taking a collaborative multidisciplinary approach to the nation’s number-one reason for hospitalization in patients over age 65.

That lack of input from emergency physicians is glaringly obvious in the weak quality of the new acute heart failure portion of the guidelines (Circulation Apr. 14, 2009; 119:1,977-2,016), according to Dr. Hollander, professor and clinical research director of emergency medicine at the University of Pennsylvania, Philadelphia. He noted that 13 of the 18 Class 1 recommendations are a mere Level of Evidence C.

“So what we have here are guidelines written by people not in emergency medicine about emergency medicine who could find no evidence for anything they concluded they should do, but who actually have no experience treating the acute heart failure patient in the emergency department,” he spluttered.

The affront was duly noted in the editorial offices of the Annals of Emergency Medicine, where Dr. Hollander is a deputy editor, and Academic Emergency Medicine. Last week the editors of the two journals created a new joint policy statement that the journals will not publish guidelines or guideline summaries unless they include input from representatives of organized emergency medicine.